Sign up for Clever Critters' Services

E-mail address:
Home number:
Work number:
Cell number:

Best time to call back: morning afternoon evening please use email

Address line 1:
Address line 2:
City
State ZIP

Information About Your Pet

1. Name: Breed: Age: male female fixed
2. Name: Breed: Age: male female fixed
3. Name: Breed: Age: male female fixed
4. Name: Breed: Age: male female fixed
5. Name: Breed: Age: male female fixed

Are we training more than five pets?
No Yes, names listed at the end of the form.

How would you describe your pet's role in your family (like a child, buddy, protector, etc.)

Has your pet received training before? Yes No
If so, from whom?

Top five training issues, in order of importance:

Your Pet's Health

Give exact or approximate dates for

most recent vet visit
most recent rabies vaccination
List other vaccinations in the last year:
Heartworm:
Flea/tick:
Other:

List any diagnosed medical problems:

Your vet's name:
Vet clinic:

Your Pet's Environment

Tell us about the people who live in or frequently visit your home. How are they related to you and how do they get along with your pet?

1. Age: male female
2. Age: male female
3. Age: male female
4. Age: male female
5. Age: male female

Other pets who live in the home or visit frequently:

1. Age: male female
2. Age: male female
3. Age: male female
4. Age: male female
5. Age: male female

Additional Comments

Anything else to add? Write it here: